DESCRIPTION (Applicant's Description): George F. Sawaya, M.D. is a full-time faculty member in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco (UCSF). Dr. Sawaya's main interest is in evidence-based medicine, especially as it pertains to women's health. He has recently completed a two-year fellowship in epidemiology, biostatistics and research design at UCSF. Specifically, he is interested in cervical cancer screening in older women. He is strongly committed to an academic career in women's health. This proposal has four specific aims: 1) to determine the efficacy of cervical smear screening in preventing invasive cervical cancer in women >60, 2) to determine differences in compliance and disease characteristics between women >60 compared to women <60 diagnosed with invasive cervical cancer, 3) to d e t e r mine the annual incidence of cervical smear abnormalities in postmenopausal women, and 4) to determine risk factors, including use of hormonal replacement therapy, for developing cervical smear abnormalities in postmenopausal women. The first two aims will be achieved by analyzing data from the Kaiser Permanente Cervical Cancer Project. This database contains cervical smear information on 649 women diagnosed with invasive cervical cancer from 1988-1994, 130 of whom are aged 60 and older. The two studies using this dataset are designed to provide information on differences in compliance, disease characteristics and protection afforded by cervical smear screening between older women and younger women. The second and third aims will be achieved by analyzing existing data from the Heart Estrogen-progestin Study, a randomized, placebo-controlled trial of hormonal replacement therapy (HRT) in 2763 postmenopausal women. All women had normal cervical smears at trial entry and are screened annually. Determination of the incidence of smear abnormalities in this population is crucial to cost-effectiveness and decision analyses of screening protocols. Identification of risk factors would allow for more targeted screening and fewer false positive smears. Moreover, the independent risk of HRT will be assessed. Dr. Sawaya has assembled a multidisciplinary team of nationally-known sponsors who are enthusiastic about his research plan and are committed to his successful completion of this project. They are dedicated to assisting him in achieving his goal of becoming an excellent clinical investigator.